- ABN Modifiers
- American Medical Association and Current Procedural Terminology
- CMS Forms and Publications
- CMS Regional Offices
- Clinical Lab Improvement Amendment
- Comprehensive Error Rate Testing
- Electronic Health Records
- Electronic Prescribing
- Evaluation and Management Documentation Guidelines
- Federal Register
- Health Insurance Portability and Accountability Act of 1996
- Interactive Voice Response System
- Limitation of Liability (Advance Beneficiary Notice of Noncoverage)
- Local Coverage Determination
- Medically Unlikely Edits
- Medicare Coverage Database
- Medicare Electronic Data Interchange
- Medicare Fraud and Abuse
- Medicare Learning Network®
- Medicare Provider-Supplier Enrollment with NGS
- NGS Internet Resources
- NGSConnex Online Web Application Can Save Time and Money
- NGS Check Provider Enrollment Application Status Tool
- National Correct Coding Initiative
- National Coverage Determination
- National ICD-10-CM-PCS: The Next Generation of Coding
- National Provider Calls and Events
- National Provider Identifier
- National Provider Identifier Registry
- National Uniform Claim Committee
- Open Door Forums
- P.O. Box Mailing Addresses
- Patient Protection and Affordable Care Act of 2010
- Physician Quality Payment Program
- Provider Contact Center
- Provider Enrollment
- Reconsideration (Second Level of Appeal)
- Recovery Audit Program
- Redetermination (First Level of Appeal)
- Skilled Nursing Facility Consolidated Billing
- U.S. Government Printing Office
- Washington Publishing Company
National Coverage Determination
NCDs are policies developed by CMS that indicates whether and under what circumstances certain services are covered under the Medicare Program. NCDs are the same for all contractors across the country.
Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). NCDs are made through an evidence-based process, with opportunities for public participation. In some cases, CMS' own research is supplemented by an outside technology assessment and/or consultation with the MEDCAC. In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on an LCD.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 amended several portions of the NCD development process in which took place on 1/1/2004.
The CMS published a Federal Register notice, (78 FR 48164-69), updating the process used for opening, deciding or reconsidering NCDs under the Social Security Act (the Act). The notice further outlines an expedited administrative process, using specific criteria, to remove certain NCDs older than ten years since their most recent review, thereby enabling local Medicare contractors to determine coverage under the Act.
To request a reconsideration of NCDs, please refer to the NCD reconsideration process instructions found on the Medicare Coverage Database page.
Interested parties may submit national coverage requests and national coverage reconsideration requests electronically to NCDRequest@cms.hhs.gov or in writing to:
Centers for Medicare & Medicaid Services
Director, Coverage and Analysis Group
7500 Security Blvd. (Mailstop C1-09-06)
Baltimore, MD 21244.
Visit How to Request an NCD for additional information.
Reviewed 10/13/2023